Sustained-release Madopar HBS compared with standard Madopar in the long-term treatment of de novo parkinsonian patients.

In this Danish-Norwegian randomized double-blind parallel-group multicentre study, we compared the therapeutic response of slow-release Madopar HBS to standard Madopar in 134 de novo patients with idiopathic Parkinson's disease during a 5-year period. The drugs were dosed according to the individual need of the patients. The Webster, NUDS, UPDRS and Hoehn & Yahr scales were used for evaluation of symptoms. Addition of a morning dose of standard Madopar 62.5 mg was allowed after 6 months. Bromocriptine could be administered but not Selegiline. Sixty-five patients got Madopar HBS and 69 standard Madopar. Surprisingly, no differences were found as to the mean daily levodopa dose, the mean number of daily doses or the use of the doses of bromocriptine. Unexpectedly, we found a trend towards a more frequent use of a morning dose of standard Madopar in the group treated with the standard formulation. No differences were observed in the occurrence of motor fluctuations or dyskinesia, the incidence of which was relatively low. Sustained-release Madopar (HBS) thus proved to be as effective as standard Madopar in the long-term treatment of de novo parkinsonian patients, but the drug showed no advantage in postponing or reducing the long-term levodopa treatment problems.

Pen injected apomorphine against off phenomena in late Parkinson's disease: a double blind, placebo controlled study.

The effect, therapeutic dose range, and pharmacokinetics of apomorphine, given as subcutaneous injections by a single use pen, were evaluated in the treatment of off phenomena in 22 patients with idiopathic Parkinson's disease. At study entry a placebo controlled apomorphine test was performed, and apomorphine doses were then individually titrated (mean 3.4 (range 0.8-6.0) mg) and compared with placebo in a double blind cross over phase. With apomorphine compared with placebo the mean daily duration of off periods was reduced by 51% as assessed by the patients and by 58% as assessed by the staff. The severity of off periods was also significantly reduced. The effect was unchanged after a maintenance phase of eight weeks. At study termination 13 of 14 patients were able to inject themselves and 11 of 14 patients found that their feeling of freedom had increased. The most common adverse events were nausea, subcutaneous nodules, and increased frequency of involuntary movements. Pharmacokinetics were linear and did not change with repeat dosing. The tmax ranged from five to 45 minutes (16 patients). It is concluded that pen injected apomorphine is a valuable treatment for patients with advanced Parkinson's disease with on-off phenomena.

Cardiac functioning and blood pressure of 47,XYY and 47,XXY men in a double-blind, double-matched population survey.

This paper reports the electrocardiogram measures and blood pressure of 12 men with 47,XYY, 14 men with 47,XXY, and 52 matched controls with 46,XY. The abnormal karyotypes were identified in a systematic population search for XYY and XXY men. The subjects and their matched controls were examined in a double-blind fashion. Electrocardiogram measures of 47,XYY and 47,XXY men were found to differ from those of 46,XY controls. The XYYs had longer P-R intervals, shorter QRS complexes, and nonsignificantly longer R-R intervals than their matched controls. The XXYs showed longer R-R intervals and trends for for prolonged P-R intervals and shorter QRS complexes when compared with their controls. Trends toward increased within-group variability in the XYY and XXY groups were observed in five of six variance tests, suggesting that the sex chromosome aneuploids have a cardiac condition anomaly. Blood pressure measures of 47,XYY and 47,XXY men were found not to differ from those of 46,XY men. None of the measures revealed a significant difference between the XYYs and the XXYs.

Testicular size and shape of 47,XYY and 47,XXY men in a double-blind, double-matched population survey.

This paper reports the testicular size and shape of 12 men with 47,XYY, 14 men with 47,XXY, and 52 matched controls with 46,XY. The abnormal karyotypes were identified in a systematic population search for XYY and XXY men. The subjects and their matched controls were examined in a double-blind fashion. The testes of the XYY men showed no significant differences from those of their XY controls for volume or shape. This indicates that previous reports of abnormal testes in XYYs reflect selection and publication bias and do not provide an accurate description of the condition of 47,XYY men's testicles. As expected, the testes of the XXY men were significantly smaller than those of their XY controls, and there was also a difference in shape. However, the mean size in this sample of XXYs was larger than in previous reports on Klinefelter syndrome patients, indicating that previous reports on XXYs, identified in clinics for male hypogonadism and other institutions, also suffered from selection bias.

Torticollis caused by an infratentorial tumour: three cases.

Three cases with torticollis caused by an infratentorial tumour are presented. A father and his son both had a Lindau tumour, and another patient had an ependymoma. It is stressed that torticollis may be the predominant or only sign of an infratentorial tumour, and that torticollis should always be suspected to have an organic origin.

Clonidine in the prophylaxis of migraine.

The prophylactic effect of clonidine in a dosage of 0.05 mg twice daily was investigated in 49 patients using a double-blind, crossover trial carried out in four Departments of Neurology. Seventy-one patients were originally included but 22 patients withdrew, two of them due to side effects,the remainder because of inability to keep the requisite diary, lack of drug compliance or refusal to attend the checkups. Approximately equal numbers withdrew during the clonidine and placebo periods. There was no statistically significant difference between the number of migraine attacks or between the number of severe attacks (8 hours' duration or more) during the placebo and clonidine periods. This also applied to the patients with foodstuff-provoked migraine attacks. Sixty-three patients carried through a double-blind, crossover trial with capsules containing either 125 mg tyramine or placebo. There was no significant difference between the number of patients who developed attacks after the ingestion of placebo and the number who did so after the ingestion of tyramine. The same is true of the group with foodstuff-provoked migraine. As a rule side effects were few and mild. This study has not confirmed that clonidine has any pharmacological effect in prophylaxis of migraine.

Tremor in XYY and XXY men.

In a double-blind, double-matched population survey, the tremor of 12 XYY, 14 XXY, and 52 XY men were studied clinically and by a special tremor recording equipment. XYY men were found to have a more pronounced tremor than XY normals, while XXY men were not found to differ in any definite way from normal XY men.

Six cases of cerebromedullospinal disconnection after cardiac arrest.

Six cases of cerebromedullospinal disconnection after cardiac arrest are reported. The diagnosis was based on mutism, consciousness and/or wakefulness, and global paralysis, except for some very limited motor functions, mostly eye movements. Consciousness was defined as repetitive contact with the patient by way of simple motor response. Despite of the fatal outcome in all cases, the importance of diagnosis and correct handling is stressed.